Does it matter where we measure blood pressure?

Although blood pressure measured at the brachial artery plays a central role in our understanding and management of cardiovascular risk, in recent years great emphasis has been placed on the importance of central blood pressure. It seems straightforward that knowledge of the blood pressure directly affecting the major organs is important for understanding the pathophysiology and treatment of cardiovascular risk. However, the field has been troubled by controversies over measurement techniques and difficulty in designing therapies to modify central but not peripheral blood pressure. In this review, we consider the physiology underlying the change in blood pressure through the arterial tree and how central blood pressure can be measured. In addition, we review the evidence regarding the relationship of central BP to cardiovascular disease and the effects of treatment. New measurement techniques and evidence regarding the specific benefits of therapies in modulating central haemodynamics mean that this is a rapidly developing area, and understanding the concept of central blood pressure will be vital in the future.